Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is a very common disorder affecting about 10% of the population with an increasing incidence in those above 60. It is particularly common in the obese and in those with large necks. It is characterized by a temporary stoppage in breathing or decrease in breathing that occurs multiple times during the night caused by obstruction in the airway. The fragmented, non-restful sleep that results can cause daytime problems such as headaches, abnormal fatigue, and depression. OSA is also associated with an increase incidence of hypertension and atrial fibrillation. People with OSA are at particular risk for unintentional injuries, especially motor vehicle accidents, because of their daytime sleepiness. The diagnostic test for OSA is polysomnography, a test which measures breathing during sleep. This is an overnight test that is best done in a sleep laboratory but can also be done at home. Apnea, a complete absence of airflow, and hypopnea, in which effective breathing is decreased enough to drop the blood oxygen saturation, are measured. All apneic and hypopneic episodes lasting at least 10 seconds are added up and divided by the total sleep time. If there are 15 episodes of apnea or hypopnea per hour, or if there are at least 5 episodes in the presence of symptoms, the diagnosis is made.
Once the diagnosis is confirmed, the treatment of choice is continuous positive airway pressure (CPAP) in which air pressure is administered through a mask worn during sleep. The pressure maintains open airways and the optimal pressure must be individually determined. This allows a more restful sleep, improves daytime fatigue, and seems to be helpful in the blood pressure control and some cardiac symptoms that accompany OSA. Unfortunately, almost half of people prescribed CPAP do not tolerate its use by 6 months. New styles of masks often allow more comfortable fits. Surgery to the mouth and throat for OSA is of doubtful value although bariatric surgery for weight loss is very effective in correcting OSA.